| NPI | 1881056448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: ID 55489) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID N-37637) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2017-03-28 |