| NPI | 1285674523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 131452) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 8198) |
| 363L00000X Nurse Practitioner (Licence: TN MS1119393) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2016-11-14 |