NPI | 1235612771 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9392136) |
Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: FL ARNP9392136) |
Enumeration Date | 2018-09-11 |
Last Update Date | 2021-10-18 |