NPI | 1881376317 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024188321) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 34380) |
Enumeration Date | 2023-08-03 |
Last Update Date | 2023-12-13 |