| NPI | 1730146044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5001113) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 01113) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2016-03-09 |