NPI | 1215760798 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71015782A) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: KY 1119361) |
Enumeration Date | 2024-08-21 |
Last Update Date | 2024-10-31 |