| NPI | 1932472487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN16475) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN RN169977) |
| 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-174398) | |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2021-04-13 |