| NPI | 1881669000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA UP005514B) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F332314) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2011-09-16 |