NPI | 1205399508 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 00000193250) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 00241777354) |
Enumeration Date | 2019-04-12 |
Last Update Date | 2019-06-20 |