| NPI | 1831184662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000011589) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN RN0000141362) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2011-01-25 |