| NPI | 1780718577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA UP001943c) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R098563) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2011-03-21 |