NPI | 1619438744 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.018590) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61018849) |
Enumeration Date | 2019-03-29 |
Last Update Date | 2021-05-13 |