NPI | 1447967559 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 11156) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 11156) |
Enumeration Date | 2022-10-31 |
Last Update Date | 2024-03-21 |