NPI | 1376062117 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP020089) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9373278) |
363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9373278) | |
Enumeration Date | 2017-09-13 |
Last Update Date | 2020-03-19 |