NPI | 1104311505 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A130196) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A130196) |
Enumeration Date | 2018-06-27 |
Last Update Date | 2024-01-04 |