NPI | 1396154373 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: NM CNP-02486) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NM CNP-02486) |
Enumeration Date | 2014-08-04 |
Last Update Date | 2024-04-25 |