| NPI | 1851322408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NV APN325) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CA 10625) |
| 363LF0000X Nurse Practitioner Family (Licence: FL ARNP1396252) | |
| 363LF0000X Nurse Practitioner Family (Licence: CO 109713) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2007-07-08 |