NPI | 1215963996 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 837765) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 091006311) |
Enumeration Date | 2006-06-24 |
Last Update Date | 2021-05-26 |