NPI | 1780686915 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 44860) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 150864) |
Enumeration Date | 2005-06-01 |
Last Update Date | 2023-07-04 |