| NPI | 1396804324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD AC002660) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 38364) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2020-06-11 |