NPI | 1821383217 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI 1415) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI 66045) |
Enumeration Date | 2011-06-14 |
Last Update Date | 2022-06-30 |