| NPI | 1760447437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 027125-23) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NH 027125-21) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2017-01-10 |