| NPI | 1891915047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 16187) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 143100) |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2016-12-28 |