NPI | 1699931493 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA 60101140) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 2962202) |
363LF0000X Nurse Practitioner, Family (Licence: TX 737610) | |
363LF0000X Nurse Practitioner, Family (Licence: OR 200843205RN) | |
Enumeration Date | 2008-07-31 |
Last Update Date | 2009-10-21 |