NPI | 1164512240 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95013299) |
Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: CA 519484) |
Enumeration Date | 2006-10-13 |
Last Update Date | 2024-05-13 |