NPI | 1679055636 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OK M81758) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9488641) |
Enumeration Date | 2018-09-05 |
Last Update Date | 2020-04-02 |