| NPI | 1578552188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 901896) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000006732) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2017-02-09 |