NPI | 1487398608 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP025646) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA SP025646) |
Enumeration Date | 2022-04-25 |
Last Update Date | 2024-11-06 |