NPI | 1578665121 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F335247-1) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R157969-5) |
Enumeration Date | 2006-09-03 |
Last Update Date | 2017-02-28 |