NPI | 1609864180 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA UP005328B) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R130259) |
Enumeration Date | 2005-10-10 |
Last Update Date | 2024-05-23 |