NPI | 1487140562 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 26258) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024176341) |
Enumeration Date | 2018-07-02 |
Last Update Date | 2019-09-03 |