| NPI | 1154725042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 2170762) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: FL 2170762) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2014-11-17 |