NPI | 1144759960 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5009541) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 5009541) |
363LF0000X Nurse Practitioner, Family (Licence: NC 262358) | |
Enumeration Date | 2017-06-06 |
Last Update Date | 2019-11-21 |