NPI | 1689183378 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 9358804) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9358804) |
363LG0600X Nurse Practitioner, Gerontology (Licence: FL 9358804) | |
Enumeration Date | 2017-09-25 |
Last Update Date | 2017-09-25 |