| NPI | 1417077827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 242756) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA 1061217) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2014-10-22 |