| NPI | 1154381986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 20000147952) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IA H-104402) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2007-12-28 |