NPI | 1831345776 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 13390) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9276601) |
Enumeration Date | 2008-08-12 |
Last Update Date | 2013-06-24 |