NPI | 1386033926 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011753) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95045656) |
Enumeration Date | 2015-01-20 |
Last Update Date | 2023-01-07 |