| NPI | 1497089387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024169865) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 4171) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2013-06-27 |