NPI | 1528637097 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC ROEG-UATMG) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 334075) |
Enumeration Date | 2021-06-21 |
Last Update Date | 2022-02-07 |