NPI | 1285433961 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DC NP1039090) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD AC007318) |
Enumeration Date | 2025-03-13 |
Last Update Date | 2025-06-11 |