| NPI | 1811988389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 200850042NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM R48114) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2015-03-17 |