| NPI | 1801239603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: TN APN0000017598) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000172188) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2013-05-17 |