| NPI | 1508892688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 10596) |
| Additional Taxonomies | 163WD0400X Registered Nurse, Diabetes Educator (Licence: TN APN0000010596) |
| 363L00000X Nurse Practitioner (Licence: TN 10596) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2014-10-20 |