NPI | 1427461755 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 18817) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024171932) |
163W00000X Registered Nurse (Licence: TN 162686) | |
Enumeration Date | 2014-06-04 |
Last Update Date | 2018-07-13 |