NPI | 1154753457 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 201504149NP-PP) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: MA RN2275111) |
363LP2300X Nurse Practitioner, Primary Care (Licence: OR 201504149NP-PP) | |
Enumeration Date | 2013-08-08 |
Last Update Date | 2016-01-05 |