| NPI | 1073935425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 0000018291) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 164018) |
| Enumeration Date | 2014-01-19 |
| Last Update Date | 2014-01-28 |