NPI | 1174139182 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 28243) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS WILL-45YJ7O) |
363LF0000X Nurse Practitioner, Family (Licence: TN 211443) | |
Enumeration Date | 2020-09-16 |
Last Update Date | 2022-06-21 |