| NPI | 1437144938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 200850048NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN RN121028) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2018-03-30 |