NPI | 1942855663 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2262596) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN276218) |
Enumeration Date | 2019-08-08 |
Last Update Date | 2021-03-05 |