| NPI | 1407957418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND R27770) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MT 25328) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2018-10-15 |