| NPI | 1114226404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: WI 13255-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 166741) |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2022-10-24 |