| NPI | 1801905740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: LA AP04823) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: LA RN098583) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2011-06-30 |