NPI | 1629675699 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61095878) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 11985380-4405) |
Enumeration Date | 2020-10-02 |
Last Update Date | 2020-11-15 |