| NPI | 1205052164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R791067) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MS R791067) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2014-02-11 |