| NPI | 1891005856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN APN15163) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN APN0000015163) |
| Enumeration Date | 2010-10-08 |
| Last Update Date | 2022-10-13 |