NPI | 1538617139 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 21998) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 192529) |
Enumeration Date | 2016-09-13 |
Last Update Date | 2016-11-30 |