NPI | 1316606981 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11015555) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11015555) |
363LF0000X Nurse Practitioner, Family (Licence: NY F350941) | |
Enumeration Date | 2021-12-10 |
Last Update Date | 2023-11-03 |