NPI | 1679924963 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP08815) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 904730) |
Enumeration Date | 2016-06-28 |
Last Update Date | 2023-01-04 |