NPI | 1184272189 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP020830) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN673833) |
Enumeration Date | 2019-09-03 |
Last Update Date | 2019-09-23 |