| NPI | 1104928605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R690392) |
| Additional Taxonomies | 367A00000X Advanced Practice Midwife |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2015-10-26 |