NPI | 1639923667 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11024092) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL F12220196) |
Enumeration Date | 2024-04-16 |
Last Update Date | 2024-05-01 |