| NPI | 1215326533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9357589) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9357589) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 9537589) | |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2017-02-21 |