NPI | 1063160489 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 31565) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 217742) |
Enumeration Date | 2022-03-15 |
Last Update Date | 2023-10-25 |