NPI | 1891421178 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ND R44554) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ND R44554) |
Enumeration Date | 2022-07-28 |
Last Update Date | 2024-09-11 |