NPI | 1134644487 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9486854) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-140375) |
363LF0000X Nurse Practitioner, Family (Licence: AL 1-140375) | |
Enumeration Date | 2017-08-08 |
Last Update Date | 2023-02-20 |