NPI | 1073866406 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP5718) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 22365) |
Enumeration Date | 2012-10-23 |
Last Update Date | 2019-01-21 |