| NPI | 1124202288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP010745) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 17344) |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2015-08-14 |