| NPI | 1699795534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9327019) |
| Additional Taxonomies | 246XS1301X Spec/Tech, Cardiovascular, Sonography (Licence: 26788) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2016-01-19 |