NPI | 1891393732 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95015437) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 95015437) |
363L00000X Nurse Practitioner (Licence: CA 95015437) | |
Enumeration Date | 2020-10-13 |
Last Update Date | 2024-09-11 |