NPI | 1720603558 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 26840) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61041141) |
Enumeration Date | 2020-06-08 |
Last Update Date | 2023-02-01 |