NPI | 1134572423 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95011470) |
Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: NY 307843) |
Enumeration Date | 2016-07-21 |
Last Update Date | 2024-06-26 |