| NPI | 1801402631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN AP0000028116) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: TN AP0000028116) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TN AP0000028116) | |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2026-06-23 |