| NPI | 1437490737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN APN17445) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN170681) |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2020-09-28 |