| NPI | 1427039155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 201100) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024000002) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2015-09-22 |