NPI | 1396186136 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A102733) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A102733) |
Enumeration Date | 2013-07-09 |
Last Update Date | 2025-01-20 |