| NPI | 1245576818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: TN 17247) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN APN17247) |
| Enumeration Date | 2012-12-29 |
| Last Update Date | 2022-03-29 |