NPI | 1386314102 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11014878) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11014878) |
Enumeration Date | 2021-09-14 |
Last Update Date | 2023-08-11 |