NPI | 1396207361 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-161504) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN149926) |
Enumeration Date | 2019-04-01 |
Last Update Date | 2021-01-15 |