NPI | 1033586532 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95022876) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60592750) |
363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP60592750) | |
Enumeration Date | 2015-08-31 |
Last Update Date | 2023-01-12 |