| NPI | 1992252266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 21562) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 189364) |
| 363L00000X Nurse Practitioner (Licence: KS 81327) | |
| 363L00000X Nurse Practitioner (Licence: TX AP133118) | |
| Enumeration Date | 2016-09-05 |
| Last Update Date | 2023-11-10 |