| NPI | 1467487728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA AP03572) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA RN073699) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2010-04-07 |