| NPI | 1619911955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9262155) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2015-02-13 |