| NPI | 1831474485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 16140) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 161274) |
| Enumeration Date | 2011-10-14 |
| Last Update Date | 2016-08-23 |