| NPI | 1043290604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MT 24310) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MT 24310) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2009-12-23 |