NPI | 1992296214 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61401342) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9379248) |
363L00000X Nurse Practitioner (Licence: OR 10013567) | |
Enumeration Date | 2018-05-22 |
Last Update Date | 2023-08-29 |