NPI | 1548711971 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.014709) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.407978) |
Enumeration Date | 2016-10-20 |
Last Update Date | 2016-10-20 |