| NPI | 1316485592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9340591) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9340591) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2017-02-07 |