| NPI | 1053797217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 20136) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 186614) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2015-10-07 |