NPI | 1528036944 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 002396) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 002396) |
Enumeration Date | 2006-03-10 |
Last Update Date | 2015-05-21 |