NPI | 1275799967 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5004030) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 5004030) |
363LF0000X Nurse Practitioner, Family (Licence: NC F0608042) | |
Enumeration Date | 2008-08-01 |
Last Update Date | 2016-06-11 |