| NPI | 1194070862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9186197) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL 9186197) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2018-10-26 |