NPI | 1760051106 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11013500) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 0000029647) |
Enumeration Date | 2021-06-21 |
Last Update Date | 2021-06-23 |