NPI | 1710336771 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024176539) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0024176539) |
363LW0102X Nurse Practitioner, Women's Health (Licence: VA 0024176539) | |
Enumeration Date | 2016-06-09 |
Last Update Date | 2024-06-13 |