| NPI | 1437449865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 15724) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 173190) |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2011-04-19 |