| NPI | 1285042861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 18757) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 161202) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2014-08-04 |