NPI | 1366519076 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5005242) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 25013) |
Enumeration Date | 2006-11-29 |
Last Update Date | 2013-05-14 |