| NPI | 1205191343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS r868902) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS r868902) |
| Enumeration Date | 2012-07-04 |
| Last Update Date | 2013-10-16 |