| NPI | 1417940164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000005392) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: TN RN0000044222) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2011-11-04 |