NPI | 1073192241 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95017089) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95017089) |
Enumeration Date | 2021-04-05 |
Last Update Date | 2024-02-13 |