NPI | 1932565355 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11030183) |
Additional Taxonomies | 104100000X Social Worker |
Enumeration Date | 2016-01-14 |
Last Update Date | 2023-12-20 |