| NPI | 1851445696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP0007463) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA AP007463) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2017-08-17 |