| NPI | 1013001544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS R850364) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS R850364) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2013-04-24 |