NPI | 1437621612 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F343879) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60939311) |
363LF0000X Nurse Practitioner, Family (Licence: SC APN.22455) | |
Enumeration Date | 2018-12-27 |
Last Update Date | 2020-03-25 |