NPI | 1245575315 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 001840) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 726633) |
163WC1600X Registered Nurse, Continuing Education/Staff Development (Licence: CA 726633) | |
363LF0000X Nurse Practitioner, Family (Licence: CA 22618) | |
Enumeration Date | 2012-11-30 |
Last Update Date | 2024-06-26 |