| NPI | 1477093177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN APN0000021984) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN162121) |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2017-02-28 |