| NPI | 1164854360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP07502) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: LA TAP003201) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2016-05-12 |