| NPI | 1801175484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: ID 63182) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 363LF0000X Nurse Practitioner Family (Licence: CA 95011207) | |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2020-10-19 |