| NPI | 1699787655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: OR 094006089N1 FNP-PP) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-07-08 |