| NPI | 1942520705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: SC 18521) |
| Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: TN APN14935) |
| 363L00000X Nurse Practitioner (Licence: TN APN14935) | |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2015-09-18 |