NPI | 1790746303 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 048292-23) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 048292-23-03) |
Enumeration Date | 2006-03-31 |
Last Update Date | 2023-03-07 |