NPI | 1225408461 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NC 5008061) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: VA 0024172753) |
Enumeration Date | 2015-09-30 |
Last Update Date | 2021-08-16 |