| NPI | 1346242765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP0943422) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 0943422) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2009-05-08 |