| NPI | 1255597811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1376A) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: ID N-37973) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2014-07-05 |