NPI | 1184055295 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 9500025) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95000025) |
Enumeration Date | 2013-11-29 |
Last Update Date | 2022-09-20 |