| NPI | 1003087289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R863289) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-092412) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2012-12-27 |