NPI | 1376716399 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 374258-4405) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 374258-8900) |
Enumeration Date | 2008-04-10 |
Last Update Date | 2010-11-24 |