NPI | 1275950826 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9310270) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN9310270) |
Enumeration Date | 2014-03-20 |
Last Update Date | 2022-12-08 |