| NPI | 1841376993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 3409) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 111691-9) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2008-12-22 |