| NPI | 1124420229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP 9365419) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9365419) |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2014-10-24 |