NPI | 1326612219 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11012654) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11012654) |
Enumeration Date | 2021-05-17 |
Last Update Date | 2024-11-19 |