NPI | 1316388051 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 887456) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-02219) |
Enumeration Date | 2013-07-10 |
Last Update Date | 2025-08-07 |