NPI | 1689314478 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 5016592) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC KOEL-9TZ) |
Enumeration Date | 2022-03-30 |
Last Update Date | 2022-11-09 |