| NPI | 1306195102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AK 167884) |
| Additional Taxonomies | 163WR0006X Registered Nurse Registered Nurse First Assistant (Licence: AK 33069) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2021-02-04 |