NPI | 1003804972 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 201824) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 201824) |
Enumeration Date | 2005-10-13 |
Last Update Date | 2024-07-15 |