NPI | 1699067314 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 004658) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 004658) |
Enumeration Date | 2011-05-13 |
Last Update Date | 2015-01-08 |