NPI | 1760896336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 872562) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000176) |
Enumeration Date | 2014-06-11 |
Last Update Date | 2025-04-23 |