| NPI | 1144596396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP010818) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: FL 9321437) |
| Enumeration Date | 2012-03-31 |
| Last Update Date | 2015-10-08 |