NPI | 1386953487 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 3295532) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AR A003978) |
Enumeration Date | 2010-10-07 |
Last Update Date | 2020-04-08 |