| NPI | 1972561009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI 62291) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI 51419) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2013-10-16 |