NPI | 1336449206 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9319273) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA UP006080B) |
Enumeration Date | 2010-10-26 |
Last Update Date | 2011-06-28 |