NPI | 1154402865 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 3011832) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 3011832) |
Enumeration Date | 2006-10-18 |
Last Update Date | 2023-12-14 |