| NPI | 1467582163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-1084) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP2042) |
| 163W00000X Registered Nurse (Licence: HI RN-63292) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2019-09-19 |