NPI | 1043525744 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 111172) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A096950) |
Enumeration Date | 2010-08-18 |
Last Update Date | 2022-07-21 |