NPI | 1336572205 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MT 100650) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MT 32204) |
Enumeration Date | 2013-08-15 |
Last Update Date | 2021-07-06 |