NPI | 1205518065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11028427) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9502733) |
Enumeration Date | 2023-08-02 |
Last Update Date | 2023-09-06 |