NPI | 1578296554 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95021302) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95021302) |
Enumeration Date | 2022-07-06 |
Last Update Date | 2024-02-13 |