NPI | 1669407102 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 514182) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 514182) |
Enumeration Date | 2006-07-12 |
Last Update Date | 2024-01-18 |