NPI | 1184045825 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000208) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 657249) |
Enumeration Date | 2013-12-25 |
Last Update Date | 2016-07-14 |