NPI | 1043107881 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND 202894) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 2461006) |
Enumeration Date | 2025-06-23 |
Last Update Date | 2025-06-30 |