| NPI | 1427047240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R167958) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 57454) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2013-02-12 |