| NPI | 1235213661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 11785) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 128867) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2016-09-22 |