NPI | 1184065740 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: DC RN61623) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R206155) |
Enumeration Date | 2013-07-11 |
Last Update Date | 2013-07-11 |