NPI | 1932150596 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 3283032) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ARNP3283032) |
Enumeration Date | 2006-05-16 |
Last Update Date | 2020-01-15 |