NPI | 1487372512 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 28948) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN245123) |
Enumeration Date | 2022-08-15 |
Last Update Date | 2025-05-20 |