NPI | 1538994520 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11035160) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 675030) |
Enumeration Date | 2024-09-07 |
Last Update Date | 2024-09-10 |