| NPI | 1679028856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL ARNP9337233) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9337233) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2017-04-06 |