| NPI | 1295119774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: TN 0000034642) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000251332) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2024-01-24 |