NPI | 1831769710 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 113715) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 79656) |
Enumeration Date | 2021-07-01 |
Last Update Date | 2021-07-28 |