| NPI | 1659477032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000005500) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN RN0000048943) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2022-12-20 |