| NPI | 1184633323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA VP004039B) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN295282L) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2010-03-30 |