NPI | 1043666092 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95004298) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95004298) |
Enumeration Date | 2016-05-09 |
Last Update Date | 2017-08-21 |