| NPI | 1356781124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN APN17666) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN160679) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2021-02-25 |