NPI | 1790456465 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95018505) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95018505) |
363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95018505) | |
Enumeration Date | 2021-09-23 |
Last Update Date | 2023-05-21 |