NPI | 1285049577 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9393818) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-125388) |
Enumeration Date | 2014-06-25 |
Last Update Date | 2021-08-10 |