NPI | 1184269565 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 26824) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 194453) |
Enumeration Date | 2019-11-09 |
Last Update Date | 2023-05-08 |