NPI | 1689482523 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL F02240508) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9607981) |
363L00000X Nurse Practitioner (Licence: FL 11031634) | |
Enumeration Date | 2024-12-23 |
Last Update Date | 2024-12-23 |