| NPI | 1942373717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000007648) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN0000007648) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2019-07-29 |