| NPI | 1578726485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP1025) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AK 1036) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2011-03-28 |