NPI | 1134430135 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: CA 95081245) |
Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: CT 004419) |
Enumeration Date | 2010-06-24 |
Last Update Date | 2016-09-15 |