| NPI | 1295089910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 117124) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 117124) |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2015-10-26 |