NPI | 1306169313 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP3593) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP3593) |
Enumeration Date | 2010-03-04 |
Last Update Date | 2025-01-22 |