NPI | 1578130662 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 11591) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 221516) |
Enumeration Date | 2021-06-07 |
Last Update Date | 2021-12-15 |