| NPI | 1205156254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: LA RN107034-AP06164) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: LA RN107034) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2012-07-03 |