| NPI | 1124086996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 11926) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MS R853561) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2012-10-02 |