NPI | 1275012288 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000024399) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000229541) |
Enumeration Date | 2018-08-09 |
Last Update Date | 2018-11-07 |