| NPI | 1275012288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000024399) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000229541) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2018-11-07 |