NPI | 1306396676 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL F08161087) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-124207) |
Enumeration Date | 2016-10-10 |
Last Update Date | 2016-10-10 |