NPI | 1811911837 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-826) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 17588) |
Enumeration Date | 2006-07-26 |
Last Update Date | 2015-04-22 |