NPI | 1427564137 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 209483) |
Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: LA 094013) |
Enumeration Date | 2017-12-18 |
Last Update Date | 2020-02-19 |