NPI | 1629588512 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95004825) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CA 95004825) |
Enumeration Date | 2017-10-04 |
Last Update Date | 2019-07-01 |