NPI | 1578974010 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95009002) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-76450) |
Enumeration Date | 2014-05-19 |
Last Update Date | 2018-07-18 |