NPI | 1730404658 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 250145) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL ARNP9248128) |
Enumeration Date | 2010-04-03 |
Last Update Date | 2012-09-20 |