NPI | 1447655766 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9325998) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL APRN9325998) |
Enumeration Date | 2014-10-29 |
Last Update Date | 2022-08-15 |