NPI | 1114370418 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP08855) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: LA AP08855) |
Enumeration Date | 2016-07-21 |
Last Update Date | 2021-05-04 |