NPI | 1124486568 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: HI APRN-2076) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CA 95003536) |
Enumeration Date | 2016-01-30 |
Last Update Date | 2016-03-21 |