NPI | 1578955019 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F341255-1) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95002352) |
363LF0000X Nurse Practitioner, Family (Licence: WA 60528082) | |
Enumeration Date | 2015-02-20 |
Last Update Date | 2017-01-04 |