| NPI | 1548514649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN15111) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-066312) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2018-03-17 |