NPI | 1003432790 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5014458) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NC 5014458) |
Enumeration Date | 2020-06-18 |
Last Update Date | 2024-07-30 |