NPI | 1649672528 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 9355875) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9355875) |
Enumeration Date | 2014-09-22 |
Last Update Date | 2024-01-08 |