| NPI | 1518397132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 18153) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 138257) |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2013-11-18 |