NPI | 1548559925 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95016495) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP011317) |
Enumeration Date | 2011-04-06 |
Last Update Date | 2023-07-31 |