| NPI | 1962155028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN 31176) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 212398) |
| 207Q00000X Family Medicine (Licence: TN 31176) | |
| 363L00000X Nurse Practitioner (Licence: TN 31176) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 31176) | |
| Enumeration Date | 2022-01-30 |
| Last Update Date | 2024-03-29 |