| NPI | 1912343799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: LA AP07146) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: LA RN119373) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2014-10-28 |