NPI | 1154509628 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R881886) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA AP05425) |
Enumeration Date | 2008-02-06 |
Last Update Date | 2023-08-14 |