NPI | 1851952162 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 230937) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ F06192632) |
Enumeration Date | 2019-06-26 |
Last Update Date | 2020-05-29 |