NPI | 1871148973 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R216694) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD R216694) |
Enumeration Date | 2019-08-06 |
Last Update Date | 2022-08-25 |