NPI | 1538545272 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95009050) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F339876) |
Enumeration Date | 2015-08-05 |
Last Update Date | 2019-04-16 |