| NPI | 1316300585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ AP8495) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN152374) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2016-06-17 |