NPI | 1063870889 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9491899) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-100230) |
Enumeration Date | 2016-02-08 |
Last Update Date | 2019-12-20 |