NPI | 1629730189 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ 264882) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AZ TEMP264882) |
Enumeration Date | 2021-10-12 |
Last Update Date | 2022-10-27 |