NPI | 1700016698 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201150192NP) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MT RN39486) |
Enumeration Date | 2009-07-25 |
Last Update Date | 2020-03-31 |