| NPI | 1265491294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: GA RN113417) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: GA RN113417) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2012-07-18 |