NPI | 1689962730 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA AP06696) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA TAP002648) |
Enumeration Date | 2011-07-11 |
Last Update Date | 2023-02-13 |