| NPI | 1588611495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: UT 200970-4405) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: UT 200970-4405) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2012-08-31 |