NPI | 1629435102 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.013755) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 19531) |
Enumeration Date | 2016-01-28 |
Last Update Date | 2022-04-20 |