| NPI | 1467618868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A-121972) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NE 1821) |
| 363LF0000X Nurse Practitioner, Family (Licence: NE 110979) | |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2010-11-03 |