| NPI | 1154827798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9256167) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: FL 9256167) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2018-12-20 |