| NPI | 1730133521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA 214205) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP2892752) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2013-08-20 |