| NPI | 1164662540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000014156) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN136610) |
| Enumeration Date | 2009-02-25 |
| Last Update Date | 2009-07-27 |