| NPI | 1194785238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA VP004569B) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 046045-23) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2012-10-04 |