NPI | 1275931529 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA F1214088) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 624771) |
363LF0000X Nurse Practitioner, Family (Licence: CA 950000516) | |
Enumeration Date | 2014-12-17 |
Last Update Date | 2014-12-18 |