NPI | 1285921312 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WV 68999) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 3006910) |
Enumeration Date | 2011-07-10 |
Last Update Date | 2021-04-22 |