| NPI | 1134599715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000020384) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN215548) |
| Enumeration Date | 2015-09-25 |
| Last Update Date | 2016-04-08 |