| NPI | 1356528616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R853885) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP06172) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2014-04-08 |