NPI | 1962029637 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95013722) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95013722) |
Enumeration Date | 2020-06-29 |
Last Update Date | 2021-09-16 |