NPI | 1114482130 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11001391) |
Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: FL APRN11001391) |
Enumeration Date | 2019-02-04 |
Last Update Date | 2019-03-22 |