NPI | 1700267507 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 841-13229) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-136329) |
Enumeration Date | 2015-06-17 |
Last Update Date | 2023-03-21 |