NPI | 1255786273 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5008606) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5008606) |
Enumeration Date | 2016-04-27 |
Last Update Date | 2023-05-19 |