NPI | 1134827017 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 27068) |
Additional Taxonomies | 363LX0106X Nurse Practitioner, Occupational Health (Licence: SC 27068) |
Enumeration Date | 2023-02-20 |
Last Update Date | 2024-10-31 |