NPI | 1255718680 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ AP9691) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN157789) |
Enumeration Date | 2015-05-06 |
Last Update Date | 2018-11-19 |