NPI | 1821465071 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 199087) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 199087) |
Enumeration Date | 2015-08-24 |
Last Update Date | 2021-08-26 |