NPI | 1235273749 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95008930) |
Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: CA NP95008930) |
Enumeration Date | 2007-02-16 |
Last Update Date | 2023-09-26 |