| NPI | 1487874848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN RN0000113741) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000007557) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2007-07-08 |