NPI | 1649210899 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN1838752) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN1838752) |
Enumeration Date | 2006-06-07 |
Last Update Date | 2025-07-02 |