| NPI | 1427349224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 15618) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 180760) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2012-03-15 |