NPI | 1033780739 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 20211016497) |
Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: MO 20211016497) |
Enumeration Date | 2021-07-05 |
Last Update Date | 2021-07-08 |