NPI | 1891727699 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 13312) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-2027) |
Enumeration Date | 2006-07-06 |
Last Update Date | 2025-08-05 |