NPI | 1154088268 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP024504) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP024504) |
Enumeration Date | 2021-11-23 |
Last Update Date | 2024-01-08 |