NPI | 1114708138 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024188387) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: VA 0001279793) |
Enumeration Date | 2023-10-06 |
Last Update Date | 2023-10-06 |