| NPI | 1962458257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9168451) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 193850) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2010-12-02 |