| NPI | 1275774051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000014020) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TN 14020) |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2022-03-21 |