| NPI | 1346286218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN APN10675) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN RN131390) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-07-01 |