NPI | 1386967354 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 14796) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 136618) |
Enumeration Date | 2010-03-05 |
Last Update Date | 2010-03-25 |