NPI | 1447966411 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 216160) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 5017469) |
363L00000X Nurse Practitioner (Licence: NC 5017469) | |
Enumeration Date | 2023-01-24 |
Last Update Date | 2024-01-17 |