| NPI | 1396109070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AL F0616615) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-070325) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2016-06-11 |