NPI | 1477189371 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95015763) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP145495) |
Enumeration Date | 2020-03-23 |
Last Update Date | 2020-11-10 |