| NPI | 1043257843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN RN00000100379) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN6999) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2012-02-28 |