NPI | 1801905740 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: LA AP04823) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: LA RN098583) |
Enumeration Date | 2006-08-30 |
Last Update Date | 2011-06-30 |