| NPI | 1437158961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000007219) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 106268) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2013-11-12 |