NPI | 1891388856 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 230897) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NV 840039) |
Enumeration Date | 2021-02-19 |
Last Update Date | 2025-09-09 |