NPI | 1336698018 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95029695) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ND R47370) |
363LF0000X Nurse Practitioner, Family (Licence: MN 6838) | |
163W00000X Registered Nurse (Licence: GA RN204584) | |
363LF0000X Nurse Practitioner, Family (Licence: GA RN204584) | |
Enumeration Date | 2016-09-23 |
Last Update Date | 2024-07-16 |