NPI | 1194267161 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2016039173) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-82533-102) |
Enumeration Date | 2016-11-08 |
Last Update Date | 2024-10-29 |