| NPI | 1588963912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 15735) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 154620) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2011-04-13 |