| NPI | 1336178334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA 080639) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 136868) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2008-12-03 |