| NPI | 1619076726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9287154) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN APN0000012121) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2014-05-16 |