NPI | 1720315336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 19738) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA20650) |
Enumeration Date | 2009-11-03 |
Last Update Date | 2012-06-11 |