NPI | 1780100917 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-127120) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WY 53464) |
Enumeration Date | 2017-08-18 |
Last Update Date | 2024-01-11 |