NPI | 1225741762 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5017523) |
Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: NC 5017523) |
363LP2300X Nurse Practitioner, Primary Care (Licence: NC 5017523) | |
Enumeration Date | 2022-12-29 |
Last Update Date | 2024-01-25 |