| NPI | 1518325463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN APN0000020290) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TN 20920) |
| Enumeration Date | 2016-02-07 |
| Last Update Date | 2023-02-02 |