| NPI | 1619187283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 14954) |
| Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: TN 153426) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: TN 14954) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2017-05-05 |