NPI | 1528099231 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 1996264405) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 8900CS) |
Enumeration Date | 2006-07-05 |
Last Update Date | 2007-07-08 |