NPI | 1265049431 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-136707) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-136707) |
Enumeration Date | 2020-09-30 |
Last Update Date | 2023-06-29 |