| NPI | 1184788572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN RN0000046481) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AR A01147 ANP) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2014-08-19 |