NPI | 1477194611 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARPN11003870) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11003870) |
Enumeration Date | 2019-09-30 |
Last Update Date | 2020-11-17 |