NPI | 1659380715 |
---|---|
Doing Business As | |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 1756-033) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 116879-030) |
Enumeration Date | 2006-08-07 |
Last Update Date | 2023-12-04 |