NPI | 1841292869 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 813415) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA RN495203 NP9973) |
Enumeration Date | 2005-08-10 |
Last Update Date | 2019-01-29 |