NPI | 1346564200 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 1142) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP 60128758) |
Enumeration Date | 2010-03-22 |
Last Update Date | 2019-10-11 |