NPI | 1275916785 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 6771305-4405) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60573923) |
363LF0000X Nurse Practitioner, Family (Licence: OR 201607350NP-PP) | |
363LF0000X Nurse Practitioner, Family (Licence: ID 66093) | |
Enumeration Date | 2015-07-01 |
Last Update Date | 2022-09-23 |