| NPI | 1154481547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NM CNP00824) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM R37709) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2014-08-26 |