NPI | 1073182085 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11013617) |
Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL 11013617) |
Enumeration Date | 2021-06-23 |
Last Update Date | 2021-06-23 |