NPI | 1083942825 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 200950064NP) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60105167) |
Enumeration Date | 2009-12-04 |
Last Update Date | 2018-03-17 |