NPI | 1770218653 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11021910) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA 283241) |
Enumeration Date | 2022-07-23 |
Last Update Date | 2022-11-24 |