NPI | 1568028967 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024177598) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 25604) |
Enumeration Date | 2019-05-13 |
Last Update Date | 2025-06-02 |