| NPI | 1235443508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP010898) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA RN322432L) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2010-08-17 |