NPI | 1093790503 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-648) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN092969) |
Enumeration Date | 2005-12-08 |
Last Update Date | 2020-08-04 |