| NPI | 1184022980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP 9371130) |
| Additional Taxonomies | 176B00000X Midwife (Licence: FL MW300) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2016-05-24 |