| NPI | 1003110016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN APN0000015236) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 15236) |
| 207Q00000X Family Medicine (Licence: TN 15236) | |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2023-09-29 |