| NPI | 1356462972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA ap05145) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN080575) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2008-04-30 |