| NPI | 1184849242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 1003) |
| Additional Taxonomies | 251B00000X Case Management |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2008-04-04 |