| NPI | 1316901309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN APN0000013941) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: TN APN0000013941) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2022-03-16 |