NPI | 1700527330 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5016488) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 280064) |
Enumeration Date | 2022-04-06 |
Last Update Date | 2022-07-27 |