| NPI | 1811311947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9317463) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9317463) |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2016-08-11 |