NPI | 1871565796 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 9223) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NPF9223 RN643640) |
Enumeration Date | 2006-02-03 |
Last Update Date | 2023-08-17 |