NPI | 1457696452 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9315397) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9315397) |
Enumeration Date | 2012-12-01 |
Last Update Date | 2015-07-07 |