| NPI | 1558844340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5011127) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NC 247595) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC FAIS-PZ4Z48) | |
| Enumeration Date | 2018-09-08 |
| Last Update Date | 2019-03-07 |