NPI | 1477565331 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP03700) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN083881) |
Enumeration Date | 2006-08-12 |
Last Update Date | 2015-05-01 |