| NPI | 1699791210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 2480) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 2480-033) |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 2480-033) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2011-07-26 |