NPI | 1952980005 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 29294) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 29294) |
Enumeration Date | 2021-04-06 |
Last Update Date | 2021-06-17 |