| NPI | 1932392586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 143887) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 143887) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2016-01-29 |