| NPI | 1760013437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000027339) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000219778) |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2020-04-08 |