NPI | 1205355211 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP028076) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP135106) |
Enumeration Date | 2017-09-12 |
Last Update Date | 2023-09-11 |