NPI | 1295351377 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP021817) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP021817) |
Enumeration Date | 2020-06-24 |
Last Update Date | 2022-11-17 |