NPI | 1699164202 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 147824) |
Additional Taxonomies | 261QA0005X Clinic/Center, Ambulatory Family Planning Facility (Licence: CA 583861) |
261QA0005X Clinic/Center, Ambulatory Family Planning Facility (Licence: AZ 147824) | |
Enumeration Date | 2015-01-20 |
Last Update Date | 2015-04-07 |