NPI | 1619710522 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NV 850216) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV 850216) |
Enumeration Date | 2024-06-17 |
Last Update Date | 2025-02-09 |