| NPI | 1740696160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 339301) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60376459) |
| 163WG0000X Registered Nurse, General Practice (Licence: NY 694998) | |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2015-01-15 |