| NPI | 1508202466 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 3295302) |
| Additional Taxonomies | 227800000X Respiratory Therapist, Certified (Licence: FL TT 12665) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2013-05-20 |