NPI | 1841657798 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 14164) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 45723) |
Enumeration Date | 2016-01-23 |
Last Update Date | 2020-01-07 |