NPI | 1063494672 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 0297872303) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP81765) |
Enumeration Date | 2005-11-18 |
Last Update Date | 2016-07-19 |