NPI | 1245097872 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95028831) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 95028831) |
Enumeration Date | 2024-02-29 |
Last Update Date | 2024-03-09 |