| NPI | 1003122821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R887805) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-110201) |
| 363L00000X Nurse Practitioner (Licence: AL 1-110201) | |
| 163W00000X Registered Nurse (Licence: MS R887805) | |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2011-08-30 |