NPI | 1639781123 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: HI APRN-3005) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-3005) |
Enumeration Date | 2020-08-18 |
Last Update Date | 2024-05-14 |