| NPI | 1215210943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN APN16106) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN APN16106) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2021-10-18 |