| NPI | 1306075544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 203358) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 18380) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5004411) | |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2016-08-29 |