NPI | 1144659632 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2013039400) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MO 2008021336) |
Enumeration Date | 2013-11-05 |
Last Update Date | 2013-11-05 |