NPI | 1639160997 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-1691) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024166027) |
Enumeration Date | 2005-11-04 |
Last Update Date | 2015-10-23 |