| NPI | 1265428635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-444A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV APN00546) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2007-07-09 |