NPI | 1265818108 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP017790) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704287386) |
Enumeration Date | 2015-08-03 |
Last Update Date | 2022-07-21 |