| NPI | 1447545199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 5967) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 67511) |
| 363LF0000X Nurse Practitioner, Family (Licence: AK 1079) | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2012-06-05 |