NPI | 1932628831 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO F1216575) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO F1216575) |
Enumeration Date | 2017-09-12 |
Last Update Date | 2017-09-12 |