NPI | 1194725432 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 7041) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR A001321) |
363LF0000X Nurse Practitioner, Family (Licence: MS 810081) | |
Enumeration Date | 2005-07-28 |
Last Update Date | 2021-06-22 |