NPI | 1144816588 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95016117) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95174477) |
Enumeration Date | 2020-12-20 |
Last Update Date | 2020-12-20 |