NPI | 1851351332 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0110840824) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110840824) |
Enumeration Date | 2006-03-27 |
Last Update Date | 2008-05-20 |