NPI | 1366865834 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2014013266) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-76215-041) |
Enumeration Date | 2014-02-03 |
Last Update Date | 2014-06-10 |