NPI | 1215388160 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL RN135083) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-154991) |
Enumeration Date | 2016-06-22 |
Last Update Date | 2021-11-24 |