| NPI | 1295261790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: TN APN0000022499) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000180052) |
| 363LF0000X Nurse Practitioner Family (Licence: TN APN0000022499) | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2017-05-09 |