NPI | 1326752684 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 12235) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 143925) |
Enumeration Date | 2023-01-11 |
Last Update Date | 2023-11-29 |