| NPI | 1962591362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 12339) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MS A810294) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2023-06-21 |