NPI | 1689467003 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 327863) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN196998) |
Enumeration Date | 2025-05-28 |
Last Update Date | 2025-08-07 |