NPI | 1487298725 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2019001501) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2019001501) |
363LP2300X Nurse Practitioner, Primary Care (Licence: MO 2019001501) | |
Enumeration Date | 2019-10-30 |
Last Update Date | 2021-01-20 |