NPI | 1942947825 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11018377) |
Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: FL RN9521286) |
Enumeration Date | 2022-05-12 |
Last Update Date | 2022-05-12 |