NPI | 1013381391 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN213238) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: GA RN213238) |
Enumeration Date | 2015-11-24 |
Last Update Date | 2017-11-02 |