NPI | 1972042331 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95015905) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-77724-011) |
Enumeration Date | 2017-02-17 |
Last Update Date | 2023-04-24 |