| NPI | 1174566822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9297264) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 162108) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2012-02-15 |