NPI | 1972865764 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R171488) |
Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: MD M-610-132-631-954) |
Enumeration Date | 2012-06-08 |
Last Update Date | 2021-04-23 |