| NPI | 1417232018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5005374) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 193085) |
| Enumeration Date | 2011-10-14 |
| Last Update Date | 2013-09-06 |