| NPI | 1497184378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WY 34286.1346) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0990808-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN2259982) | |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2018-11-14 |