NPI | 1659860724 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 179514) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID 58454) |
Enumeration Date | 2018-05-04 |
Last Update Date | 2024-10-24 |