NPI | 1598016099 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 20163) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 76664) |
Enumeration Date | 2012-09-24 |
Last Update Date | 2021-06-10 |