| NPI | 1568069201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TN 27917) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN md0000037467) |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2021-07-02 |