| NPI | 1740229855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R140784) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9280476) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2010-11-08 |