| NPI | 1912304031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-134334) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-134334) |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2015-06-18 |