| NPI | 1639267768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AK 1372) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AR A02948) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2014-07-10 |