NPI | 1417298779 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 267800) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 17433) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 267800) | |
Enumeration Date | 2013-03-12 |
Last Update Date | 2024-08-12 |