NPI | 1972567410 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | |
Primary Taxonomy | 163WA2000X Registered Nurse Administrator (Licence: PA RN291968L) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: PA SP006447B) |
Enumeration Date | 2006-04-13 |
Last Update Date | 2007-07-08 |