| NPI | 1528309945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 17575) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 183861) |
| Enumeration Date | 2013-03-11 |
| Last Update Date | 2013-04-16 |