NPI | 1083015887 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95006240) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN170793) |
Enumeration Date | 2014-09-11 |
Last Update Date | 2018-03-17 |