| NPI | 1780930677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R887697) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS R887697) |
| Enumeration Date | 2012-07-28 |
| Last Update Date | 2012-07-28 |