| NPI | 1851604904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201050116NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID NP1166A) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2014-12-09 |