NPI | 1396209805 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 25428) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 25428) |
Enumeration Date | 2019-01-29 |
Last Update Date | 2024-03-03 |