| NPI | 1194100891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA ap08468) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA rn119291) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2015-07-22 |