NPI | 1225384415 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 22379) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 306068) |
Enumeration Date | 2012-07-25 |
Last Update Date | 2023-12-12 |