| NPI | 1144379488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 334815) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: DC 1013851) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2014-12-24 |