| NPI | 1881923720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R216748) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP010531) |
| Enumeration Date | 2009-12-23 |
| Last Update Date | 2016-11-17 |