| NPI | 1568587251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9199867) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA 143028) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |