NPI | 1225682511 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 210673) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 210673) |
Enumeration Date | 2019-07-25 |
Last Update Date | 2021-02-16 |