| NPI | 1194267765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 22019) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: TN 22019) |
| Enumeration Date | 2016-11-13 |
| Last Update Date | 2017-01-24 |