NPI | 1578207999 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 9637623-4405) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 9637623-4405) |
Enumeration Date | 2022-04-21 |
Last Update Date | 2023-08-09 |