| NPI | 1851352074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R176141) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP007774) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2014-01-30 |