NPI | 1386985513 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: PA SP012742) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA SP012742) |
Enumeration Date | 2013-03-13 |
Last Update Date | 2016-03-13 |