NPI | 1619656147 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 34302) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN281594) |
Enumeration Date | 2023-07-12 |
Last Update Date | 2024-11-04 |