NPI | 1003165135 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 22074) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 593398) |
Enumeration Date | 2012-09-05 |
Last Update Date | 2022-10-27 |