| NPI | 1508912833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP03949) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R119966) |
| Enumeration Date | 2007-01-27 |
| Last Update Date | 2016-07-27 |