NPI | 1366570020 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE 110626) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IA A097758) |
Enumeration Date | 2007-03-02 |
Last Update Date | 2019-06-14 |