NPI | 1376523530 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 98734) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 15655) |
Enumeration Date | 2006-01-21 |
Last Update Date | 2014-01-29 |