NPI | 1053911339 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 215856) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA 215856) |
Enumeration Date | 2020-10-27 |
Last Update Date | 2023-02-28 |