NPI | 1467574459 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0001194626) |
Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: VA 0001194626) |
Enumeration Date | 2007-04-03 |
Last Update Date | 2024-04-23 |