NPI | 1255085445 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95035037) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NV 824560) |
363LF0000X Nurse Practitioner, Family (Licence: NV 824560) | |
Enumeration Date | 2022-02-07 |
Last Update Date | 2025-08-27 |