NPI | 1992249437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 8306305-8900) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: UT 8306305-3102) |
363LF0000X Nurse Practitioner, Family (Licence: UT 8306305-4405) | |
Enumeration Date | 2016-12-16 |
Last Update Date | 2017-04-25 |