| NPI | 1477565331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP03700) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN083881) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2015-05-01 |