| NPI | 1932246683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP00581) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM R29549) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2013-07-01 |