| NPI | 1841447174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2010033190) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 3491-033) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2012-03-27 |