NPI | 1134123995 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71000351A) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3545P) |
Enumeration Date | 2005-06-09 |
Last Update Date | 2014-05-08 |