NPI | 1609582287 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10007749) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 805921) |
163W00000X Registered Nurse (Licence: OR 10007749) | |
363LF0000X Nurse Practitioner, Family (Licence: TX 1099834) | |
Enumeration Date | 2023-01-26 |
Last Update Date | 2024-07-19 |