| NPI | 1649539164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1159A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID N-37724) |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2013-06-21 |