| NPI | 1366416042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN RN72732) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN6129) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2007-07-08 |