NPI | 1609502657 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11035589) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95031847) |
363L00000X Nurse Practitioner (Licence: NY 355285) | |
363L00000X Nurse Practitioner (Licence: AZ 314884) | |
Enumeration Date | 2022-07-30 |
Last Update Date | 2024-10-30 |