| NPI | 1609287499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000018820) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000165292) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2014-07-08 |