NPI | 1912304031 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-134334) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-134334) |
Enumeration Date | 2014-12-04 |
Last Update Date | 2015-06-18 |