| NPI | 1427461755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 18817) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024171932) |
| 163W00000X Registered Nurse (Licence: TN 162686) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2018-07-13 |