| NPI | 1023398682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 16069) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: TN 180746) |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2018-10-15 |