| NPI | 1043540396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 14494) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 14494) |
| Enumeration Date | 2010-01-09 |
| Last Update Date | 2016-05-23 |