NPI | 1114538642 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 25836) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11001929) |
Enumeration Date | 2020-08-10 |
Last Update Date | 2025-06-28 |