NPI | 1619271681 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5010394) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 4430) |
Enumeration Date | 2011-01-05 |
Last Update Date | 2020-10-26 |