NPI | 1891133369 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 227309) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60627765) |
363LF0000X Nurse Practitioner, Family (Licence: TN APN0000017603) | |
363LF0000X Nurse Practitioner, Family (Licence: OR 201906750-NP-PP) | |
363LP2300X Nurse Practitioner, Primary Care (Licence: AK 116687) | |
Enumeration Date | 2013-06-06 |
Last Update Date | 2022-11-07 |