NPI | 1982188173 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9251269) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN9251269) |
Enumeration Date | 2018-09-24 |
Last Update Date | 2025-03-27 |