| NPI | 1144409566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000006366) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS R874581) |
| 363LF0000X Nurse Practitioner, Family (Licence: MS R874581) | |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2015-10-07 |