| NPI | 1407415490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000026064) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS R882648) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2019-07-16 |