NPI | 1669208443 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP030889) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN683177) |
Enumeration Date | 2024-09-10 |
Last Update Date | 2024-10-23 |