| NPI | 1134265739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 4278) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71002332A) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2018-03-26 |