| NPI | 1649642653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 20529) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TN 172885) |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2015-10-29 |