| NPI | 1255009114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN0000029981) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 906168) |
| 363LF0000X Nurse Practitioner, Family (Licence: MS 906168) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000029981) | |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2023-10-18 |