NPI | 1225456304 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP07641) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID 63614) |
Enumeration Date | 2014-04-04 |
Last Update Date | 2023-02-06 |