NPI | 1982043758 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP5148) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ rn128391) |
Enumeration Date | 2013-06-14 |
Last Update Date | 2024-08-14 |