NPI | 1114402500 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-145244) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-145244) |
Enumeration Date | 2018-10-01 |
Last Update Date | 2024-08-08 |