NPI | 1477606846 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 11005766) |
Additional Taxonomies | 174400000X Specialist (Licence: FL MA36367) |
363LF0000X Nurse Practitioner, Family (Licence: FL 11005766) | |
Enumeration Date | 2007-01-19 |
Last Update Date | 2022-10-04 |