NPI | 1245027622 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11038132) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA 242664) |
Enumeration Date | 2025-04-21 |
Last Update Date | 2025-09-04 |