NPI | 1972020410 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95014501) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9339943) |
363LF0000X Nurse Practitioner, Family (Licence: FL APRN9339943) | |
Enumeration Date | 2017-08-25 |
Last Update Date | 2020-08-31 |