NPI | 1447832191 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-152645) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-152645) |
Enumeration Date | 2021-04-22 |
Last Update Date | 2023-04-17 |