| NPI | 1023263357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KS TMP139491) |
| Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: OR 200741852RN) |
| Enumeration Date | 2008-12-01 |
| Last Update Date | 2009-09-12 |