| NPI | 1780690974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AK 672) |
| Additional Taxonomies | 367A00000X Advanced Practice Midwife (Licence: AK 672) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |