| NPI | 1033317789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OR 200750111NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CA 698033) |
| Enumeration Date | 2007-07-04 |
| Last Update Date | 2009-12-01 |