NPI | 1225679087 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 825146) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 825146) |
Enumeration Date | 2019-10-03 |
Last Update Date | 2020-01-03 |