| NPI | 1235241860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN APN8421) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN 8421) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-07-12 |