| NPI | 1922015031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 2117926) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP1550942) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2009-12-08 |