| NPI | 1205293198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN20804) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN192497) |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: TN EMT16137) | |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2017-05-08 |