| NPI | 1891768024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A096018) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NE 110745) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2009-01-26 |