| NPI | 1083841993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 13559) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN APN0000013559) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2022-03-31 |