NPI | 1508014853 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 19033) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP05772) |
Enumeration Date | 2008-08-28 |
Last Update Date | 2024-06-18 |