NPI | 1235897281 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95024357) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95242868) |
Enumeration Date | 2021-12-07 |
Last Update Date | 2024-06-19 |