| NPI | 1295115400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 9227981) |
| Additional Taxonomies | 363LW0102X Nurse Practitioner, Women's Health (Licence: FL 9227981) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL 9227981) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 9227981) | |
| 363LC1500X Nurse Practitioner, Community Health (Licence: FL 9227981) | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2016-08-07 |