NPI | 1811171408 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS R878258) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ARNP1604312) |
Enumeration Date | 2007-12-19 |
Last Update Date | 2010-07-09 |