NPI | 1962577841 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 14946) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 14946) |
363LG0600X Nurse Practitioner, Gerontology (Licence: CA 14946) | |
Enumeration Date | 2006-11-23 |
Last Update Date | 2007-07-08 |