| NPI | 1184029753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9358814) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9358814) |
| 227900000X Respiratory Therapist, Registered (Licence: FL RT11063) | |
| Enumeration Date | 2014-10-25 |
| Last Update Date | 2015-03-09 |