NPI | 1790343796 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 229212) |
Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: GA 272689) |
Enumeration Date | 2019-06-04 |
Last Update Date | 2021-01-27 |