NPI | 1407342306 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP10092) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: LA RN133156) |
Enumeration Date | 2018-07-03 |
Last Update Date | 2018-07-03 |