NPI | 1083138226 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: LA AP09479) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MS 902063) |
Enumeration Date | 2017-07-31 |
Last Update Date | 2022-07-21 |