| NPI | 1154679405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP06985) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA RN113429) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2012-08-16 |