NPI | 1598522708 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11031963) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9516660) |
Enumeration Date | 2024-03-04 |
Last Update Date | 2024-04-04 |