| NPI | 1376093955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN21852) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 21852) |
| 163W00000X Registered Nurse (Licence: TN RN210243) | |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2018-10-10 |