NPI | 1982384129 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 34307) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024187654) |
Enumeration Date | 2023-07-21 |
Last Update Date | 2023-10-18 |