NPI | 1083042618 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11002944) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL rn9325936) |
207Q00000X Family Medicine (Licence: FL APRN11002944) | |
Enumeration Date | 2013-10-16 |
Last Update Date | 2019-07-30 |