NPI | 1023382207 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD AC003216) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024169733) |
Enumeration Date | 2012-03-06 |
Last Update Date | 2023-02-09 |