NPI | 1265803225 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011551) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP128865) |
Enumeration Date | 2015-10-15 |
Last Update Date | 2019-10-09 |