NPI | 1770643231 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD AC000290) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0001151805) |
363L00000X Nurse Practitioner (Licence: DC RN61669) | |
Enumeration Date | 2006-12-12 |
Last Update Date | 2012-01-03 |