NPI | 1225261027 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 13148) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 513743) |
Enumeration Date | 2009-08-26 |
Last Update Date | 2012-10-25 |