NPI | 1134933344 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11035818) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 354715) |
Enumeration Date | 2025-02-06 |
Last Update Date | 2025-02-06 |