NPI | 1598765786 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP1757172) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL MD.32707) |
Enumeration Date | 2005-07-28 |
Last Update Date | 2017-01-05 |