NPI | 1275121733 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 1021162) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1021162) |
Enumeration Date | 2021-01-08 |
Last Update Date | 2022-08-18 |