| NPI | 1902065873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 515) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AK 18425) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2008-06-05 |