NPI | 1508237587 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN002363) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95003197) |
Enumeration Date | 2015-10-15 |
Last Update Date | 2022-12-02 |