NPI | 1396355327 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP022592) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 309784) |
Enumeration Date | 2020-08-04 |
Last Update Date | 2023-12-04 |