NPI | 1093164667 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL aprn9343190) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9343190) |
Enumeration Date | 2016-06-06 |
Last Update Date | 2020-04-06 |