| NPI | 1467552414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 7082) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 002696) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2016-10-19 |