| NPI | 1548355936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN7797) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 7797) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-03-31 |