NPI | 1033673439 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 012867) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11000876) |
Enumeration Date | 2019-01-30 |
Last Update Date | 2024-04-26 |