NPI | 1780155366 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11000304) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 5013019) |
Enumeration Date | 2018-12-07 |
Last Update Date | 2024-06-05 |