| NPI | 1831548213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9328218) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9328218) |
| 376G00000X Nursing Home Administrator (Licence: FL 9328218) | |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2016-11-21 |