| NPI | 1790738656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 022686-23-03) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9211895) |
| 163W00000X Registered Nurse (Licence: NH 022686-21) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2010-05-20 |