| NPI | 1205814738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 135539) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 135539) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2012-03-02 |