NPI | 1023275955 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP007430) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP007430) |
Enumeration Date | 2008-05-19 |
Last Update Date | 2024-11-05 |