NPI | 1407097520 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5004343) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 171146) |
Enumeration Date | 2009-03-19 |
Last Update Date | 2022-02-09 |