| NPI | 1528667037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN APN0000032851) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000224773) |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2022-12-13 |