NPI | 1316281314 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95000267) |
Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: CA 95000267) |
Enumeration Date | 2012-11-15 |
Last Update Date | 2022-12-08 |