NPI | 1740229053 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704321379) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM R54642) |
363L00000X Nurse Practitioner (Licence: OR 2005500339NP/40NP) | |
Enumeration Date | 2006-06-05 |
Last Update Date | 2016-10-26 |