NPI | 1578561262 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS 810467) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 16792) |
363LF0000X Nurse Practitioner, Family (Licence: TN APN0000016792) | |
Enumeration Date | 2005-07-07 |
Last Update Date | 2023-06-27 |