NPI | 1033704127 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 13489) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000028158) |
Enumeration Date | 2021-03-02 |
Last Update Date | 2023-06-15 |