NPI | 1326694647 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11028085) |
Additional Taxonomies | 104100000X Social Worker |
163W00000X Registered Nurse (Licence: FL RN9484541) | |
Enumeration Date | 2019-08-13 |
Last Update Date | 2024-01-24 |