NPI | 1649712563 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9404039) |
Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: FL APRN9404039) |
363L00000X Nurse Practitioner (Licence: FL APRN9404039) | |
Enumeration Date | 2016-11-09 |
Last Update Date | 2025-03-03 |