| NPI | 1124018783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WA AP60001922) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IA A-061573) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2014-09-20 |