NPI | 1104559822 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ND R42006) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ND R42006) |
Enumeration Date | 2022-07-09 |
Last Update Date | 2025-07-18 |