NPI | 1376049213 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9333709) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 9333709) |
Enumeration Date | 2018-03-31 |
Last Update Date | 2024-01-09 |