NPI | 1972266070 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5015265) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 268646) |
Enumeration Date | 2021-10-16 |
Last Update Date | 2023-04-14 |