| NPI | 1235171257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN APN10948) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN RN128174) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2013-11-26 |