NPI | 1659978609 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC APN.26071) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI 3053) |
363LF0000X Nurse Practitioner, Family (Licence: NC 5016379) | |
Enumeration Date | 2020-10-02 |
Last Update Date | 2023-01-30 |