NPI | 1174032122 |
---|---|
Professional Name | CARLOS EDUARDO BONILLA |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 5250948-4405) |
Enumeration Date | 2017-09-21 |
Last Update Date | 2018-03-17 |