NPI | 1376928713 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP016105) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001976) |
Enumeration Date | 2015-07-28 |
Last Update Date | 2017-11-01 |