| NPI | 1134239270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 12157) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN APN0000012157) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2014-11-04 |