NPI | 1467833459 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP016031) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95002513) |
Enumeration Date | 2015-06-15 |
Last Update Date | 2024-02-05 |