| NPI | 1043524713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2010026853) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 5375290081) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2011-02-07 |