| NPI | 1982050258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9389083) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9389083) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2019-10-02 |