NPI | 1356933691 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-168767) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-168767) |
Enumeration Date | 2021-02-08 |
Last Update Date | 2024-11-18 |