NPI | 1851917264 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 7472) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 7472) |
Enumeration Date | 2020-06-22 |
Last Update Date | 2021-02-17 |