NPI | 1205076130 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 200842264RN) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 199782-4405) |
Enumeration Date | 2009-03-05 |
Last Update Date | 2011-12-12 |