NPI | 1053704668 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 11003) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 524935) |
Enumeration Date | 2015-03-07 |
Last Update Date | 2015-03-07 |