NPI | 1750867248 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A130813) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA F07181382) |
Enumeration Date | 2018-07-17 |
Last Update Date | 2021-09-13 |