| NPI | 1245413640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5003979) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 3407) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2016-08-15 |