| NPI | 1811998362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 81002649) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID NP239A) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2014-02-27 |