NPI | 1164807806 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R186203) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R186203) |
Enumeration Date | 2015-07-23 |
Last Update Date | 2015-11-09 |