| NPI | 1134238462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM CNP00502) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM R26378) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2013-07-16 |