NPI | 1437558061 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS F0115273) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MS R874310) |
Enumeration Date | 2014-08-20 |
Last Update Date | 2021-11-09 |