| NPI | 1881643393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MS R860220) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA 1116211) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2011-06-17 |