| NPI | 1225294770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA RN056659 AP05551) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA RN056659 AP05551) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2011-06-20 |