NPI | 1225605025 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95024492) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA NP95013688) |
Enumeration Date | 2021-06-09 |
Last Update Date | 2023-06-14 |