NPI | 1255914511 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95024420) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95135355) |
Enumeration Date | 2021-05-04 |
Last Update Date | 2023-02-24 |