NPI | 1538731419 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE 113660) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 113660) |
Enumeration Date | 2021-07-12 |
Last Update Date | 2021-07-19 |