NPI | 1053378646 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11012723) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 190702) |
Enumeration Date | 2006-04-27 |
Last Update Date | 2024-04-01 |