NPI | 1558856534 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-57744) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9414225) |
363LF0000X Nurse Practitioner, Family (Licence: WA AP60962413) | |
Enumeration Date | 2018-06-22 |
Last Update Date | 2020-03-02 |