NPI | 1417566647 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006228) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11006228) |
363LF0000X Nurse Practitioner, Family (Licence: FL 11006228) | |
Enumeration Date | 2020-07-23 |
Last Update Date | 2020-09-10 |