| NPI | 1285990663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R114317) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD R114317) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2012-04-10 |