| NPI | 1255339636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NH 052864-23) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 900375) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2011-11-21 |