NPI | 1326030727 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: MI 4704146078) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704146078) |
Enumeration Date | 2005-08-22 |
Last Update Date | 2007-07-15 |