NPI | 1821762600 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN10115591) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL RN9518408) |
Enumeration Date | 2021-08-04 |
Last Update Date | 2023-01-11 |