NPI | 1346924172 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95026476) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95196188) |
Enumeration Date | 2023-06-12 |
Last Update Date | 2023-09-01 |