NPI | 1417679762 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11021418) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11021418) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: FL 11021418) | |
363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11021418) | |
363LX0106X Nurse Practitioner, Occupational Health (Licence: FL 11021418) | |
261QM1300X Clinic/Center, Multi-Specialty (Licence: FL 11021418) | |
261QU0200X Clinic/Center, Urgent Care (Licence: FL 11021418) | |
Enumeration Date | 2022-09-14 |
Last Update Date | 2024-09-15 |