NPI | 1548679244 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP08096) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS R889798) |
Enumeration Date | 2014-08-06 |
Last Update Date | 2021-09-09 |