| NPI | 1962469726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 18991) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024165037) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2014-09-05 |