| NPI | 1053304378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MT 33092) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 200550091NP) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2014-09-10 |