NPI | 1942722376 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11022778) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9463152) |
Enumeration Date | 2017-07-07 |
Last Update Date | 2024-08-02 |