NPI | 1871227132 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP025906) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP025906) |
Enumeration Date | 2022-07-13 |
Last Update Date | 2023-08-14 |