| NPI | 1992285308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 24573) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 24573) |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2018-08-15 |