| NPI | 1154341774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1071723) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS R881863) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2014-05-23 |