| NPI | 1962896415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WA AP60541983) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL ARNP 9324637) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2015-04-15 |