NPI | 1174302350 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95212940) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95027407) |
Enumeration Date | 2023-09-26 |
Last Update Date | 2024-08-23 |