| NPI | 1932502549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA Sp014252) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA Rn615840) |
| Enumeration Date | 2014-09-28 |
| Last Update Date | 2014-09-28 |