NPI | 1578077467 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DC RN1039297) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1039297) |
Enumeration Date | 2017-11-30 |
Last Update Date | 2017-11-30 |