NPI | 1356032072 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 27374) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 27374) |
Enumeration Date | 2023-05-15 |
Last Update Date | 2023-05-19 |