NPI | 1235572728 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 22487) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 775296) |
Enumeration Date | 2013-04-15 |
Last Update Date | 2013-04-15 |