NPI | 1104221167 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA np95001434) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA np95001434) |
363LG0600X Nurse Practitioner, Gerontology (Licence: CA np95001434) | |
363LP2300X Nurse Practitioner, Primary Care (Licence: CA np95001434) | |
Enumeration Date | 2014-11-01 |
Last Update Date | 2015-04-03 |