| NPI | 1245653252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 211467) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: LA RN124998) |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2020-01-28 |