NPI | 1033718986 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11009951) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL F09201237) |
Enumeration Date | 2020-10-21 |
Last Update Date | 2021-12-22 |