NPI | 1609589233 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP026790) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP026790) |
Enumeration Date | 2022-12-28 |
Last Update Date | 2023-03-29 |