NPI | 1912431727 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 5081) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN CNP5081) |
Enumeration Date | 2017-04-18 |
Last Update Date | 2020-10-06 |