NPI | 1013654995 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95017584) |
Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA 95017584) |
Enumeration Date | 2022-05-12 |
Last Update Date | 2022-08-05 |