NPI | 1700879459 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID NP-704A) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-704) |
Enumeration Date | 2005-08-29 |
Last Update Date | 2012-11-15 |