| NPI | 1457334633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN RN108204) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 108204) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2010-03-05 |