| NPI | 1528463387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 9358430) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9358430) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2015-06-16 |