| NPI | 1881001543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 18867) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN165362) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2014-07-21 |