| NPI | 1184065740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: DC RN61623) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R206155) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2013-07-11 |