| NPI | 1982714853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 139217) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 139217) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2008-02-27 |