NPI | 1578654224 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: UT 197032-4405) |
Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: UT 197032-4405) |
Enumeration Date | 2006-09-27 |
Last Update Date | 2017-09-12 |