NPI | 1629099122 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 252839) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 2679622) |
Enumeration Date | 2006-07-21 |
Last Update Date | 2017-04-17 |