NPI | 1700408804 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11007397) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL 9372778) |
363LF0000X Nurse Practitioner, Family (Licence: FL 11007397) | |
Enumeration Date | 2020-05-12 |
Last Update Date | 2025-10-13 |