| NPI | 1063441574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 169795) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 169795) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2014-12-09 |