NPI | 1003660945 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 15422) |
Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: WI 248849-30) |
Enumeration Date | 2024-04-16 |
Last Update Date | 2024-08-02 |