NPI | 1881292217 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11009700) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9423575) |
Enumeration Date | 2020-10-16 |
Last Update Date | 2024-08-29 |