NPI | 1508490475 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006282) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL APRN11006262) |
Enumeration Date | 2020-02-28 |
Last Update Date | 2021-03-30 |