NPI | 1588147193 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9357693) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9357693) |
Enumeration Date | 2018-09-10 |
Last Update Date | 2023-09-08 |