NPI | 1609600600 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95034962) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 355097) |
Enumeration Date | 2024-08-30 |
Last Update Date | 2025-09-03 |