NPI | 1275169518 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006656) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11006656) |
Enumeration Date | 2020-03-18 |
Last Update Date | 2020-03-30 |