NPI | 1093496200 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95027595) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical |
Enumeration Date | 2023-07-31 |
Last Update Date | 2024-04-03 |