NPI | 1417618729 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95020376) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95068351) |
Enumeration Date | 2022-01-07 |
Last Update Date | 2025-09-11 |