NPI | 1629305172 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95008208) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1005781) |
363LF0000X Nurse Practitioner, Family (Licence: VA 0024168515) | |
363LF0000X Nurse Practitioner, Family (Licence: FL ARNP-9360991) | |
363LF0000X Nurse Practitioner, Family (Licence: PA SP012948) | |
363LF0000X Nurse Practitioner, Family (Licence: NM CNP-02221) | |
Enumeration Date | 2009-11-04 |
Last Update Date | 2022-04-11 |