NPI | 1538562145 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95000650) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000650) |
Enumeration Date | 2014-09-27 |
Last Update Date | 2023-05-05 |