| NPI | 1477743490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5005864) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 12741) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2016-10-19 |