| NPI | 1326482589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP07282) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA RN122807) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2014-08-19 |