NPI | 1689797029 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 7662) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 349096) |
Enumeration Date | 2007-04-09 |
Last Update Date | 2020-04-02 |