| NPI | 1881948784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN 0000224906) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4714) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ RN145306) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 22864) | |
| Enumeration Date | 2012-10-31 |
| Last Update Date | 2021-07-07 |