NPI | 1245876499 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 235030) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN185478) |
Enumeration Date | 2019-11-22 |
Last Update Date | 2020-01-22 |