| NPI | 1891904132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID NP-817A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID NP817A) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2010-11-23 |