| NPI | 1851531800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 201861) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 122695) |
| Enumeration Date | 2009-03-04 |
| Last Update Date | 2009-08-05 |