| NPI | 1215483466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 21620) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 182127) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2017-02-02 |