| NPI | 1528360450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5010581) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 313575) |
| 163W00000X Registered Nurse (Licence: NC 304575) | |
| Enumeration Date | 2010-11-29 |
| Last Update Date | 2018-06-25 |