| NPI | 1336449206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9319273) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA UP006080B) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2011-06-28 |