NPI | 1649784984 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-103117) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN273998) |
Enumeration Date | 2017-11-22 |
Last Update Date | 2019-06-21 |