NPI | 1861222481 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 13024) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11033282) |
Enumeration Date | 2024-08-07 |
Last Update Date | 2025-09-12 |