| NPI | 1992708911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN APN7542) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN RN113668) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2013-10-28 |