NPI | 1194230805 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95007795) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP95007795) |
Enumeration Date | 2017-12-05 |
Last Update Date | 2024-02-27 |