| NPI | 1740452119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 45635) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 126684) |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2012-08-21 |