NPI | 1063909398 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MD R193259) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DE LP-0010374) |
363L00000X Nurse Practitioner (Licence: MD R193259) | |
Enumeration Date | 2018-04-23 |
Last Update Date | 2020-08-04 |