NPI | 1346594165 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95016427) |
Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 259885) |
Enumeration Date | 2012-10-31 |
Last Update Date | 2023-11-02 |