NPI | 1558904904 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 6899) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 6899) |
Enumeration Date | 2019-10-17 |
Last Update Date | 2023-11-21 |